Intra-Abdominal Pressure monitoring
WSACS (World Society of Abdominal Compartment Syndrome) recommends that patients should be screened for IAH/ACS risk factors upon ICU admission and in the presence of new or progressive organ failure. WSACS has generated consensus definitions and shares knowledge on diagnosis, management and treatment of IAH and ACS. http://archive.wsacs.org/consensus.php
By utilizing the protocols based on the guidelines from the World Society on Abdominal Compartment Syndrome (WSACS), clinicians can monitor IAP in patients at risk and intervene in order to improve patient outcomes. 1, 2, 3
Management of patients according to an algorithm including both operative and nonoperative interventions has been shown to increase patient survival whilst reducing ICU and hospital length of stay.4
The Dangerous Progression of Intra-Abdominal Hypertension
Patients undergoing resuscitation, especially in the setting of systemic inflammation, will “leak” intravascular fluid into their tissue. Large amounts of this fluid can accumulate in the abdomen as both free fluid and interstitial edema. As this fluid accumulates the pressure in the abdomen begins to rise5. Once the intra-abdominal pressure (IAP) exceeds 12 mmHg it is defined as intra-abdominal hypertension (IAH)1, a syndrome found in as many as 30-50% of critically ill patients5, 6*. Left unnoticed IAH may progress to multiple organ dysfunction, the abdominal compartment syndrome and death.
Unfortunately, IAH cannot be identified through physical examination7. and therefore proper detection and management of IAH requires screening of all patients at risk for IAH by monitoring their IAP. A common method of measuring IAP is via transduction of the pressure through the bladder using a Foley catheter.
The Dangerous Progression Poster illustrates what happens to the patient’s body as the severity of the illness increases. It highlights the patient’s signs, symptoms and physiologic effects along with what can be done (interventions) to manage IAH.
- Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006; 32:1722–1732.
- Cheatham ML, Malbrain, ML, Kirkpatrick, A et al. Results from the International Conference of Experts on Intra‐abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007; 33:951–962.
- Cheatham ML. Nonoperative Management of Intraabdominal Hypertension and Abdominal Compartment Syndrome. World J Surg. 2009 Jun;33(6):1116‐22
- Cheatham, ML, Safcsak RN. Is the evolving management of intra‐abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med, 2010. 38(2); 402‐407
- Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intra-abdominal hypertension in a mixed population of critically ill patients: A multiple-center epidemiological study. Crit Care Med. 2005;33 (2):315-322.
- Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med (2004) 30:822–829.
- Sugrue M, Bauman A, Jones F et al. Clinical Examination is an Inaccurate Predictor of Intra-abdominal Pressure. World J. Surg. 2002;26:1428-1431.
* Reported incidence and prevalence of IAH varies depending upon definition, patient population, frequency of measurement and reporting of mean or maximal values.